Kyle Russell O'Donnell, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00201989 Issued in CO

Practice address

200 W County Line Rd Ste 210
Highlands Ranch, CO 80129-2342

Phone

(303) 791-0413

NPI assigned

Oct 18, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Charles N.Theobald D.D.S.,P.C.

  • General Practice Dentistry
  • Highlands Ranch, CO
  • NPI 1356701072
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1982957775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W COUNTY LINE RD STE 210",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292342",
            "telephone_number": "702-338-5991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W COUNTY LINE RD STE 210",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292342",
            "telephone_number": "303-791-0413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24112 E Orchard Rd",
            "address_2": "Building LF-09",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800165349",
            "country_code": "US",
            "telephone_number": "888-890-3719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'DONNELL",
        "first_name": "KYLE",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-18",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "6313",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00201989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mansur Nurdel, O.D.
• Ryan Nuss
• Amy Nutsch
• Sylvan O'Brien
• Braden Douglas O'Dell, DC
• Erin Elizabeth O'Flaherty, M.D.
• Oak Tree Behavioral Services
• OB-GYN Affiliates
• Occupational Health Centers of the Southwest P.a. (Concentra Medical Center)
• Rosa Yamil Ochoa Andujo, RDN

• Dentist in Highlands Ranch, CO
• Providers in Highlands Ranch, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.